Basic Information
| Provider Information | |||||||||
| NPI: | 1316126428 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY ANESTHESIOLOGY INC PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14841 179TH AVE SE STE 220 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982721127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608631508 | ||||||||
| FaxNumber: | 3608059781 | ||||||||
| Practice Location | |||||||||
| Address1: | 14841 179TH AVE SE STE 220 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982721127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608631508 | ||||||||
| FaxNumber: | 3608059781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2007 | ||||||||
| LastUpdateDate: | 11/02/2007 | ||||||||
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| AuthorizedOfficialLastName: | SHROFF | ||||||||
| AuthorizedOfficialFirstName: | ASHOK | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 3608631508 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD00030088 | WA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.